Ellis, John L

Ellis, John L is an individual health care provider with primary practice located at 3800 N Mesa Ste C8, El Paso TX 79902. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Ellis, John L can be contacted via phone (915) 533-1811.

Contact Information

Primary practice address
3800 N Mesa Ste C8 El Paso TX 79902
Phone: (915) 533-1811
Fax: (915) 533-3641
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 5395T6 Texas

Profile Details

NPI number 1417947417
LBN Legal business name Ellis, John L
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 21st, 2005
Last updated Oct 20th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417947417 NPPES
New Mexico Other 06654720 MEDICAID
New Mexico Other 143852 MEDICAID
New Mexico Other 4722920001 MEDICAID
New Mexico MEDICAID 160390401 MEDICAID
New Mexico Other 5395 MEDICAID
New Mexico Other 807829 MEDICAID
New Mexico Other 914210 MEDICAID
New Mexico Other P00113768 MEDICAID

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